Brian L. Cole is with the Health Science Department, California State University, Long Beach, and the Center for Healthy Climate Solutions, University of California, Los Angeles. Irish Del Rosario is with the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. Astrid Hendricks is with BCT Partners, Pasadena, CA. David P. Eisenman is with the Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, and the Centers for Public Health and Disasters and Healthy Climate Solutions, Fielding School of Public Health, University of California, Los Angeles.
Am J Public Health. 2023 Feb;113(2):185-193. doi: 10.2105/AJPH.2022.307143.
Despite broad agreement that prioritizing health equity is critical to minimizing the health impacts of climate change, there is a lack of clarity about what advancing health equity means in practice. More than reducing health disparities; it also implies engaging and empowering marginalized communities. We propose a typology of health equity processes, focused on building community agency and power, and then apply it to a nonrepresentative, purposive sample of 48 community-based climate actions (CBCAs) selected from lists of projects funded by foundations and state climate programs and from other sources. All CBCAs were in the United States, community-based, active since 2015 or more recently, engaged in climate mitigation or adaptation, and stated health equity aims. Two team members reviewed project reports to assess the engagement of vulnerable and marginalized populations, agency-building, and transformation of community power relationships. Although 33 CBCAs reported efforts to build community agency, only 19 reported efforts to increase community power. City-led CBCAs showed less emphasis on agency-building and power transformation. This typology can support efforts to advance health equity by providing concrete indicators to diagnose gaps and track progress. ( 2023;113(2):185-193. https://doi.org/10.2105/AJPH.2022.307143).
尽管人们普遍认为优先考虑健康公平对于将气候变化对健康的影响降到最低至关重要,但在实践中推进健康公平意味着什么还缺乏明确性。这不仅仅意味着减少健康差距;它还意味着让边缘化社区参与并赋予他们权力。我们提出了一种健康公平进程的分类法,重点是建立社区机构和权力,然后将其应用于从基金会和州气候计划资助的项目清单以及其他来源中选择的 48 个非代表性、有目的的社区气候行动(CBCA)的非代表性、有目的的样本中。所有的 CBCA 都在美国,是基于社区的,自 2015 年以来一直在积极开展,参与气候缓解或适应,并且明确了健康公平目标。两名团队成员审查了项目报告,以评估弱势和边缘化人群的参与情况、机构建设以及社区权力关系的转变。尽管 33 个 CBCA 报告了努力建立社区机构的情况,但只有 19 个报告了努力增加社区权力的情况。由城市主导的 CBCA 显示出对机构建设和权力转变的重视程度较低。这种分类法可以通过提供具体的指标来诊断差距和跟踪进展,从而支持推进健康公平的努力。(2023;113(2):185-193. https://doi.org/10.2105/AJPH.2022.307143)。